Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201004173 | MI |
NPI | 1902383037 |
---|---|
Provider Name | Linda Kuball |
First Address | Baroda, MI 49101-8902 |
Second Address | Bridgman, MI 49106-9002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2018 |
Last Update Date | 21/07/2018 |